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Medical ethics and related topics such as data protection are often viewed as extraneous encumberments by researchers. However these fields provide guidelines for correct conduct and are mostly common sense. This Best Practice Guideline collection will focus on various related aspects pertaining to ethics in publication, and this paper will outline the key points in each of these papers in the collection. [ABSTRACT FROM AUTHOR]

Child undernutrition is responsible for 45% of all under‐five deaths in low‐ and middle‐income countries (LMICs) and numerous morbidities. Although progress has been made, high levels of child undernutrition persist in Zambia. Existing studies have explored primary caretakers' (PCs) explanatory models of child undernutrition in LMICs, without comparison with those of health care providers (HCPs). This paper examines and compares the perceived causes of child undernutrition among PCs and HCPs in Zambia. We conducted a qualitative study, using semistructured one‐to‐one and group interviews, with 38 PCs and 10 HCPs to explore their perceptions of child undernutrition and its perceived causes in Lusaka district, Zambia. Interview data were analysed with thematic analysis. Our findings indicate that PCs and HCPs in Lusaka district have divergent explanatory models of child undernutrition and perceive parental agency differently. In divergently framing how they conceptualise undernutrition and who is able to prevent it, these models underpin different attributions of causality and different opportunities for intervention. PCs highlighted factors such as child food preferences, child health, and household finances. Contrarily, HCPs stressed factors such as 'improper feeding', only highlighting factors such as wider economic conditions when these impacted specifically on health care services. One factor, identified by both groups, was 'inadequate mothering'. To accelerate the reduction of child undernutrition, interventions must address divergences between PCs and HCPs' explanatory models. Additionally, attention needs to be paid to how wider socio‐economic and cultural contexts not only impact childhood undernutrition but shape attributions of causality. [ABSTRACT FROM AUTHOR]

This paper recounts the difficulties experienced when the authors sought access to children in hospital for social research interviews. These were part of a 2-year study, funded by the Joseph Rowntree Foundation, aiming to explore the numbers, circumstances and experiences of children who spend prolonged periods in health care settings. As the intention was to carry out ‘guided conversations’ with 24 young people in various different NHS locations, permission to do so was sought from a multi-site research ethics committee (MREC), and from several local research ethics committees (LRECs). Agreement was then necessary from NHS trusts, which were asked to nominate a liaison person to help identify and recruit children to the study. Consent was also required from individual parents and children. A series of unexpected delays encountered during this process are discussed in some detail. Eventually a sample of 15 children was achieved. The second part of the paper locates this experience within a wider context, noting that similar difficulties gaining access to children in NHS settings have recently been reported by other social researchers. Several possible reasons for this trend are identified and discussed. These relate to the role of MRECs and LRECs in screening social research proposals, recently implemented legislation about data protection, heightened concerns within the NHS about confidentiality and consent, and increasing awareness of the risk of child abuse in health care settings. Finally, some suggestions for facilitating the access process are discussed. They include the sensitive and appropriate application of research governance frameworks to social research – including studies within health care settings. Ethical considerations and adequate protection of children are vital but, the authors argue, wherever possible children themselves should be encouraged to decide whether or not to participate in research. In addition, unnecessarily complex access procedures may adversely affect research outcomes. [ABSTRACT FROM AUTHOR]

Over 90% of deaths attributable to malaria are in African children under 5 years old. Yet, new treatments are often tested primarily in adult patients and extrapolations have proven to be sometimes invalid, especially in dosing regimens. For studies in severe malaria an additional complication is that the decline in severe malaria in adult patients precludes sufficiently powered trials in adults, before the intervention can be tested in the ultimate target group, paediatric severe malaria. In this paper we propose an alternative pathway to the development of drugs for use in paediatric severe malaria. We argue that following the classical phase I and II studies, small safety and efficacy studies using well-chosen surrogate endpoints in adult severe malaria be conducted, instead of larger mortality endpoint trials. If the drug appears safe and promising small pilot studies in paediatric severe malaria using the same endpoints can follow. Finally, with carefully observed safeguards in place to ensure high ethical standards, promising candidate interventions can be taken forward into mortality endpoint, well-powered, large paediatric studies in African children with severe malaria. Given the available research capacity, limited numbers of prudently selected interventions can be studied in phase III trials, and adaptive designs should be considered. [ABSTRACT FROM AUTHOR]

Pediatric psychologists have much to contribute to growing efforts to mitigate the impact of parent mental and behavioral health problems on children's health and development. However, providing parent-focused psychological services within the pediatric setting brings many new ethical considerations and challenges. Guided by the American Psychological Association's Ethics Code, this paper presents an ethical case for providing these types of services, followed by a comprehensive analysis of the unique ethical challenges likely to be encountered when doing so. Recommendations are offered to support the ethical delivery of parent-focused psychological services in pediatric settings. [ABSTRACT FROM AUTHOR]

Copyright of Acta Pediátrica Española is the property of Ediciones Mayo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We describe an ontological approach to childhood studies that we refer to as Childhood Ethics. This involves an interdisciplinary hermeneutic orientation towards examining the morally meaningful dimensions of matters that affect young people. We draw on our empirical research with young people from 3‐ to 17‐years old, examining their experiences in a diversity of contexts and geographical settings. Our investigations challenge dominant binary conceptions of young people along lines of decisional in/capacity and im/maturity. We argue for a view of children as active agents with meaningful relational engagements and participation interests and capacities and outline corresponding implications for research and practice. [ABSTRACT FROM AUTHOR]

Much of the contemporary debate about the propriety of non-therapeutic circumcision of male infants and boys revolves around the question of risks vs. benefits. With its headline conclusion that the benefits outweigh the risks, the current circumcision policy of the American Academy of Pediatrics [AAP] (released 2012) is a typical instance of this line of thought. Since the AAP states that it cannot assess the true incidence of complications, however, critics have pointed out that this conclusion is unwarranted. In this paper it is argued that the AAP's conclusion is untenable not only for empirical reasons related to lack of data, but also for logical and conceptual reasons: the concept of risk employed--risk of surgical complications--is too narrow to be useful in the circumcision debate. Complications are not the only harms of circumcision: the AAP and other parties debating the pros and cons of circumcision should conceptualize their analysis more broadly as risk of harm vs. prospect of benefit, thereby factoring in the value of the foreskin to the individual and the physical and ethical harms of removing it from a non-consenting child. [ABSTRACT FROM AUTHOR]

Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics. [ABSTRACT FROM AUTHOR]

Copyright of Motricidade is the property of Silabas Didaticas LDA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Although adaptation and proper biological functioning require developmental programming, pollutant interference can cause developmental toxicity or DT. Objectives: This commentary assesses whether it is ethical for citizens/physicians/scientists to allow avoidable DT. Methods: Using conceptual, economic, ethical, and logical analysis, the commentary assesses what major ethical theories and objectors would say regarding the defensibility of allowing avoidable DT. Results: The commentary argues that (1) none of the four major ethical theories (based, respectively, on virtue, natural law, utility, or equity) can consistently defend avoidable DT because it unjustifiably harms, respectively, individual human flourishing, human life, the greatest good, and equality. (2) Justice also requires leaving �as much and as good� biological resources for all, including future generations possibly harmed if epigenetic change is heritable. (3) Scientists/physicians have greater justice-based duties, than ordinary/average citizens, to help stop DT because they help cause it and have greater professional abilities/opportunities to help stop it. (4) Scientists/physicians likewise have greater justice-based duties, than ordinary/average citizens, to help stop DT because they benefit more from it, given their relatively greater education/consumption/income. The paper shows that major objections to (3)-(4) fail on logical, ethical, or scientific grounds, then closes with practical suggestions for implementing its proposals. Conclusions: Because allowing avoidable DT is ethically indefensible, citizens�and especially physicians/scientists�have justice-based duties to help stop DT. [ABSTRACT FROM AUTHOR]

This paper examines the consequences of parental migratory strategies for children in three types of Mexican families: those living with their migrant parents in the United States, those living with parents who migrated and returned to Mexico, and those living in Mexico with parents who have never migrated. Using data on 804 children from the Health and Migration Survey (HMS), we found significant differences in children’s health across the three types of families. Results also revealed robust effects on child health of the size of immediate and extended social networks and migration experience after controlling for potential mediators such as mother’s general health, receipt of social support, and child’s age and sex. Findings suggest that social networks and migration affect children in complex ways, offering health benefits to those with migrant parents in U.S. households but not to those living with parents who migrated in the past and returned to Mexico. [ABSTRACT FROM AUTHOR]

The methodology of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study raises a number of important ethical questions. Many of these are already well recognised in ethical guidelines that uphold principles of individual and parental consent, confidentiality and scientific review. There are, however, wider issues that require ethical reflection. In this paper, we focus on a set of problems surrounding the evaluation of complex social interventions, and argue that comprehensive and objective evaluation is a much more ethically charged aim than it may first appear. In particular, we contend that standard scientific measures-of body size and biomarkers-convey only part of the story. This is partly because, when we intervene in communities, we are also concerned with complex social effects. These effects are made even more complex by contemporary social anxieties about fat and physical appearance, as well as about the safety and security of children. Such anxieties increase the risk of undesirable side effects that are themselves difficult to gauge. In the face of these and other complexities, we argue that the evaluation of interventions should involve a strong ethical dimension. First, it must include-as does the IDEFICS study-consideration of the opinions of the people affected, who are subjected to interventions in ways that necessarily go beyond individual consent. Second, we suggest that interventions might also be assessed by how much they empower people-and especially those persons, such as children, who are otherwise often disempowered. [ABSTRACT FROM AUTHOR]

Background In 1988, the European Association for Children in Hospital (EACH) established a charter of rights setting out the guiding principles for the treatment of children in hospital. Our aim was to ascertain whether children, parents and staff in a children's hospital believe the European Charter is conformed to. Methods A total of 111 parents (response rate = 90%), 50 children (response rate = 100%), 61 nurses (response rate = 55%) and 41 doctors (response rate = 25%) agreed to participate. Questionnaires based on the 10 rights in the EACH Charter were administered to children, parents and staff. Results The majority of children and parents were happy with the relationship they had with staff. However, the findings suggest that children, parents and staff are concerned with the lack of facilities in hospital, including parental accommodation, play, education, age-appropriate wards and lack of privacy. Staff felt that many children undergo unnecessary admission and treatment in hospital. Many staff are reluctant to discuss issues such as side effects of medications with patients and do not encourage children to ask questions. Contrary to expectations, clinicians were reluctant to consider children under 16 as capable of giving consent, and most parents and children felt that children should be over 17 and 18 respectively. Conclusion This paper highlights patients' and staff's perceptions regarding children's rights in hospital and discusses the changes needed to fully conform to the EACH Charter. [ABSTRACT FROM AUTHOR]

Abstract: A convergence of issues suggests that protecting child health is not so much a matter of research, but rather a matter of policy and advocacy. First, we have well-articulated views of a vision for child health. Second, we have experience and toxicological research findings demonstrating the adverse health effects of hazardous chemicals on children and recognize that children are more sensitive than adults to chemical exposures. Results from toxicology research have motivated many regulatory and legal actions, and public policy decisions, including the banning of some pesticides, reducing exposures in the workplace, and lowering of acceptable blood lead levels in children. We also know that childhood disabilities from chemical exposure during developmental are often not treatable and therefore must be prevented. Finally, we have an increasingly well-defined framework for discussing social and ethical responsibility to our children. New discoveries in the basic biological and toxicological sciences have challenged our bioethical thinking and societal decision-making. This paper will explore the ethical, legal, and social issues raised by the toxicological sciences first by examining some hard lesson learned about childhood effects of chemicals and then by examining the difficult policy and research decisions that must be made as we address our need for additional information about the health effects of chemicals on adults and children and the impact of having this information. The precautionary principle will be considered as an alternative decision-making approach as well as exploring the concept of the citizen toxicologist (CT). As Garrett Hardin pointed out many years ago, the problems we face often have no technical solutions, but rather require a policy-based approach. This paper will be of interest to the public and health professionals concerned about the broader impact of toxicological research on bioethical and societal decision-making. [Copyright &y& Elsevier]

This paper describes secondary analysis of previously unreported data collected during the 2014 Australian Human Rights Commission Inquiry into Children in Immigration Detention. The aim was to examine the mental health of asylum-seeking parents and children during prolonged immigration detention and to consider the human rights implications of the findings. The average period of detention was seven months. Data includes 166 Kessler 10 Scales (K10) and 70 Strengths and Difficulties Questionnaires (SDQ) for children aged 3-17 and parental concerns about 48 infants. Extremely high rates of mental disorder in adults and children resemble clinical populations. The K10 indicated severe co-morbid depression and anxiety in 83% of adults and 85.7% of teenagers. On the SDQ, 75.7% of children had a high probability of psychiatric disorder, with lower conduct and hyperactivity scores than clinic populations. Sixty-seven percent of parents had concerns about their infant's development. Correlations were not found between time detained or parent/child distress. Multiple human rights breaches are identified, including the right to health. This is further evidence of the profound negative consequences for adults and children of prolonged immigration detention. Methodological limitations demonstrate the practical and ethical obstacles to research with this population and the politicized implications of the findings. [ABSTRACT FROM AUTHOR]

The impacts of the lack of skin tone diversity in medical education images on healthcare professionals (HCPs) and patients are not well studied. The aim of this study was to assess the diagnostic knowledge of HCPs and correlate this with confidence and training resources used. An online multiple choice quiz was developed. The participants' demographics, training resources and self-confidence in diagnosing skin conditions were collected. The differences in the results between the subgroups and the correlations between the respondents' experience, self-reported confidence and quiz results were assessed. The mean score of 432 international participants was 5.37 (SD 1.75) out of a maximum of 10 (highest score). Eleven percent (n = 47) reached the 80% pass mark. Subanalysis showed no difference by the continent (p = 0.270), ethnicity (p = 0.397), profession (p = 0.599), training resources (p = 0.198) or confidence (p = 0.400). A significance was observed in the specialty (p = 0.01). A weak correlation between experience and confidence (Spearman's ρ = 0.286), but no correlation between scores and confidence or experience (ρ = 0.087 and 0.076), was observed. Of diagnoses, eczema was recognised in 40% and meningococcal rash in 61%. This is the first study assessing the identification of paediatric skin conditions in different skin tones internationally. The correct identification of common/important paediatric conditions was poor, suggesting a possible difference in knowledge across skin tones. There is an urgent need to improve the representation of all skin tones to ensure equity in patient care. [ABSTRACT FROM AUTHOR]

This is an exciting time for research and novel drug development in cystic fibrosis. However, rarely has the adage, "Children are not just little adults" been more relevant. This article is divided into two main sections. In the first, we explore why it is important to involve children in research. We discuss the potential benefits of understanding a disease and its treatment in children, and we highlight that children have the same legal and ethical right to evidence-based therapy as adults. Additionally, we discuss why extrapolation from adults may be inappropriate, for example, medication pharmacokinetics may be different in children, and there may be unpredictable adverse effects. In the second part, we discuss how to involve children and their families in research. We outline the importance and the complexities of selecting appropriate outcome measures, and we discuss the role co-design may have in improving the involvement of children. We highlight the importance of appropriate staffing and resourcing, and we outline some of the common challenges and possible solutions, including practical tips on obtaining consent/assent in children and adolescents. We conclude that it is unethical to simply rely on extrapolation from adult studies because research in young children is challenging and that research should be seen as a normal part of the paediatric therapeutic journey. [ABSTRACT FROM AUTHOR]

Copyright of Psychiatria Polska is the property of Editorial Committee of Polish Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Discussions about current and future immunisation programmes raise novel questions about familiar ethical issues. Two sets of ethical issues dominate these discussions. The first is the issue of compulsory immunisation: what should be done about parents who fail to immunise their children? The second is: given competing demands on health care budgets, how should principles of justice in access and distribution inform vaccination programmes? This paper considers these two issues in the light of traditional ethical principles. With respect to the first, we argue that compulsion is justified only in cases in which we know with practical certainty that parental failure to immunise puts their own child or other children at high risk of severe illness. We also argue that the state should compensate those who suffer vaccine-related injury. With respect to the second, we claim that allocating resources according to health care need requires establishing priorities between public health programmes such as immunisation and other treatment programmes. [Copyright &y& Elsevier]

The paper presents the ethical and methodological issues of the scientific research in children. The ethic requirements for a scientific research are: its importance for health, scientific validity, subjects selection, favourable risk-benefit ratio, independent review, informed consent and respect for the enrolled subjects. Confidentiality is very important for subjects protection. The research Ethics Committees are the forum approveing the research. [ABSTRACT FROM AUTHOR]

Photovoice, a way of conducting research through pictures, is considered a child-friendly method to engage children in participatory research and social change but this practice can raise ethical dilemmas. These dilemmas have rarely been discussed in the literature. The aim of this article is to provide insight into the ethical dilemmas we faced using photovoice with children. It is grounded in a 4-year participatory health research project in two primary schools where we used photovoice alongside other creative and arts-based methods. We reflect critically on pressing ethical tensions and how we dealt with these dilemmas. Our logbooks and reflexive conversations were used as data sources. The findings reveal that everyday ethical dilemmas occurred throughout the project. These were sometimes anticipated but were often unexpected. Questions that arose included: 'Who controls the outcome?'; 'Photos to assess needs or to give voice?'; 'Giving voice or aesthetics?'; 'Who decides who is visible?' and 'Disrespectful and stereotypical representations?' We conclude that ethical dilemmas in using photovoice with children deserve more attention to sensitize researchers and help them live up to the ideals of voice and empowerment. [ABSTRACT FROM AUTHOR]

Quality improvement (QI) has tremendous potential to tackle the shortcomings of health services. But health professionals have not yet fully embraced QI as part of their day-to-day concerns. Indeed, QI is sometimes experienced as a brake on quality rather than a catalyst for improvement. This can happen, for example, if there is too much emphasis on meeting short-term institutional goals rather than on addressing long-term health needs. This emphasis also risks equating quality with safety and efficiency measures while neglecting patient-centredness and equity. QI does not have to be like this. We suggest that the conscientious and critical engagement of health professionals in QI can lead to genuinely better and more far-reaching outcomes for child health. We also distinguish between QI projects that repair the status quo and those that seek to reform it, arguing that there is an important place for both. [ABSTRACT FROM AUTHOR]

Little ethical recommendations on returning children's individual research findings are available for researchers in behavioral sciences, especially when compared to genetic research. Anecdotic evidence suggests that since parents are often interested in their child's individual research findings, researchers tend to offer this information as a form of compensation for research participation. Despite good intentions, these practices are not without potential harmful consequences for children. We were confronted with these difficulties and with the paucity of available guidance on this topic, being involved in a longitudinal, infant development study, i.e. tracking infants at risk for autism (TIARA). First, we review current ethical recommendations and discuss their limitations in the light of the TIARA study. Second, we will suggest to revise these recommendations, by identifying and applying the relevant bioethical principles and concepts at hand. Third, as an example of practical implementation, the adopted 'return of research findings'-policy for the TIARA-study is presented. The principles and concepts we engage with are the ancillary care responsibilities of the researcher, non-maleficence and beneficence, the right to an open future of the child, and the avoidance of therapeutic misconception. Ultimately, we present the concrete return of research findings policy implemented in the TIARA-study. Here, we suggest restricting the systematic return of children's individual research findings to cases where findings are considered clinically significant and actionable for the child. We discuss the broader implications for designing and conducting research in behavioral sciences with children. [ABSTRACT FROM AUTHOR]

Copyright of Summa Psicológica UST is the property of Universidad Santo Tomas de Chile and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The care of children and adolescents whose experience of the body is at odds with their gender feelings raises a number of questions that are as much ethical as medical or psychological. In this article I highlight some areas of ethical concern from the point of view of a senior clinician at the nationally commissioned UK Gender Identity Development Service (GIDS). I make the assumption that ethical deliberation is relational and grounded in the natural, social, political and institutional worlds in which the ethical questions arise. I try to show how matters of empirical fact, alongside an appreciation of broad social contexts, and historic and current power relations, provide an essential framework for the ways that ethical choices are framed by key groups of people as they take up different, sometimes opposing, ethical positions. I argue that practising ethically in such a service is not helpfully reduced to a single event, a treatment decision aimed at achieving the morally 'right' outcome, but an extended process in time. In the charged debate surrounding the recognition of these young people's needs, we must do more to promote responsible debate about the scope of sound ethical practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including factors of mortal distress in neonatal and peadiatric intensive care, health framework on juvenile disease and its treatment.

Objective: In English paediatric practice, English law requires that parents and clinicians agree the 'best interests' of children and, if this is not possible, that the courts decide. Court intervention is rare and the concept of best interests is ambiguous. We report qualitative research exploring how the best interests standard operates in practice, particularly with decisions related to planned non-treatment. We discuss results in the light of accounts of best interests in the medical ethics literature.Design: We conducted 39 qualitative interviews, exploring decision making in the paediatric intensive care unit, with doctors, nurses, clinical ethics committee members and parents whose children had a range of health outcomes. Interviews were audio-recorded and analysed thematically.Results: Parents and clinicians indicated differences in their approaches to deciding the child's best interests. These were reconciled when parents responded positively to clinicians' efforts to help parents agree with the clinicians' view of the child's best interests. Notably, protracted disagreements about a child's best interests in non-treatment decisions were resolved when parents' views were affected by witnessing their child's physical deterioration. Negotiation was the norm and clinicians believed avoiding the courts was desirable.Conclusions: Sensitivity to the long-term interests of parents of children with life-limiting conditions is defensible but must be exercised proportionately. Current approaches emphasise negotiation but offer few alternatives when decisions are at an impasse. In such situations, the instrumental role played by a child's deterioration and avoidance of the courts risks giving insufficient weight to the child's interests. New approaches to decision making are needed. [ABSTRACT FROM AUTHOR]

Research on family instability is fertile ground for translation into policy and practice. This article describes how basic science in this area can more effectively support work in later stages of the translational research process. To begin, the scope of family instability is outlined with trends, causes, and effects. Next, a conceptual model of the effects of family instability on children's health identifies focal aspects that could be leveraged for translational research: developmental domain, developmental time, mechanisms, and points of variation. The guidelines presented are meant to be general and applicable to a variety of topics and fields in which family scholars aim to improve basic research that can contribute to and move forward a translational family science. [ABSTRACT FROM AUTHOR]

Purpose - The paper seeks to raise awareness of the issues surrounding marketing of medically implanted devices, a logical extension of issues no debated on direct-to-consumer pharmaceutical advertising. Design/methodology/approach - Parallels from the direct-to-consumer marketing of pharmaceuticals provide a context for discussion of the marketing efforts of a specific medically implanted device: cochlear implants for children. Findings - Since CI implantation is controversial among some members of the deaf community, the marketing of the product for children raises additional issues beyond those of many other devices or drugs. The omission of this concern in the marketing materials targeting parents overlook significant cultural risk that could derail desirable marketing efforts. Research limitations/implications - Researchers should initiate investigation of consumer perceptions of surgically implanted medical devices a related issues, to provide guidance for health professionals, marketers, and policymakers. Practical implications - In the interest of designing ethical messages, engendering consumer trust, and improving sales, health marketing should consider the full array of issues surrounding surgically implanted devices and design promotional messages accordingly. Originality/value - Raising important issues regarding the marketing of a surgically implanted medical device can encourage future responsible marketing of the technology. [ABSTRACT FROM AUTHOR]

Julian Savulescu's principle of procreative beneficence (PB) states that, other things being equal, and of the possible children they could have, a couple contemplating procreation are morally obliged to (attempt to) procreate the child with the best chance of the best life. The critique of PB is in three parts. The first part argues that PB rests on a particular conception of the good life, and that alternative conceptions of the good life afford no obvious way in which PB can be rendered operational. The second part identifies six flaws in the attempt to justify PB in terms of a particular conception of the good life according to which the best life is understood as the life with the most well-being. The third part explores some of the uncertainties that surround the potential implications and ramifications of adopting the principle. The overall purpose is not to demonstrate that the principle is untenable, but only to demonstrate that no compelling reason has yet been given for adhering to it. [ABSTRACT FROM AUTHOR]

Objective: To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs).Design: Pubmed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care.Results: 13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly 'burdensome' and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating 'aggressive care'. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations.Conclusions: Moral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required. [ABSTRACT FROM AUTHOR]

Adolescents may often have opinions about whether they want genetic and genomic testing in both the clinic and research and about who should have access to the results. This legal analysis demonstrates that the law provides very little protection to minors' wishes. [ABSTRACT FROM AUTHOR]

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article examines the controversial and largely publicly undocumented practice of administering electroconvulsive therapy ( ECT or electroshock) to children who are undergoing psychiatric treatment. Conventional psychiatric beliefs and practices are challenged, along with a presentation of the history of scientific research which questions electroshock's 'effectiveness' and outlines its brain-damaging and incapacitating effects. As such, we provide counterarguments regarding the legitimacy of ECT as a treatment option, deconstructing the principle of presumed prudence in its use. Our analysis leads us to conclude that the 'principle of presumed prudence' should be eschewed in favour of the 'precautionary principle', in order to underscore and uphold the medical ethos 'to do no harm' and to ensure the application of children's rights within the psychiatric system. [ABSTRACT FROM AUTHOR]

The field of gamete donation for medically assisted reproduction purposes is evolving. While anonymous gamete donation was long the preferred practice, a new focus on the rights and interests of donor-conceived children has led a number of countries to shift towards an open-identity system. However, this evolution appears to overlook whether information exchange could also be of interest to the other parties involved, in particular the gamete donors. In this article, we analyse the question whether donors should be granted a right to some information about the offspring conceived by their donations. We constructed five arguments which donors could use in support of such a claim: (i) It can be of great importance to the donors' and their own children's health that they receive medical information (in particular, evidence of an unsuspected genetic disease) about the donor offspring; (ii) basic information (such as whether any children were born) could be a way to acknowledge donors for their altruistic behaviour; (iii) general information (information about the child's wellbeing) about the donor offspring could ease the donors' potential concern about and sense of responsibility for the offspring; (iv) basic information could provide an important enrichment of the donors' identities; (v) identifying information would be useful for donors who want to contact the donor offspring. No strong arguments in favour of granting donors the right to identifying information were found. An exchange of this type of information should only be accepted when all parties agree. Taken together, the four first arguments form a strong case for granting donors a right to several types of anonymous information about the donor offspring. [ABSTRACT FROM AUTHOR]

This article attempts to map the broad ethical and legal contours of global child health realities. Its interest is in international duties to reduce disparities in the health of children. Specifically, it inquires into loci of collective rights and responsibilities in this context. Clarity on the sources of this responsibility and the nature of such rights will, it is hoped, contribute to enhanced and sustained action to attenuate these inequalities. A review and critique of the current topography of global health ethics is followed by an analysis of international human rights law as it pertains to global health, with a particular focus on the legal dimensions of child health outcomes. Thus grounded, the article seeks to build conceptual synergies between public health ethics and human rights paradigms to underwrite collective action on global child health disparities. [ABSTRACT FROM PUBLISHER]

The aim of this study was to create a new understanding of health promotion activities in the classroom setting through children's perspectives. Nineteen Swedish schoolchildren, ages 10- to 11-years-old, participated in health promotion work in the classroom. Through drawings and an exhibition discussion analysing their own and each other's drawings, they shared their lived experience of well-being and lack thereof. The phenomenological analysis resulted in three themes: (1) friends in good times and in bad; (2) the sunny side of life; (3) the bad and the mean. These themes were understood as friendship being like an extra parachute. Reflecting on the children's lived experience of well-being and our own role in the research process, the concept of openness surfaced. This we believe is an important ethical aspect of research with children. [ABSTRACT FROM AUTHOR]

This study explored Swedish school nurses' experiences of school health record documentation. Fifty per cent of a representative sample of Swedish school nurses (n=129) reported difficulties with documenting mental and social health problems in family relationships, schoolchildren's behaviour, and school situations. Ethical considerations concerning fears of misinterpretation and practical barriers to documentation were expressed as reasons for their worries. Mental and social ill health is an increasing and often dominating problem among schoolchildren, thus proper documentation is a basic issue, both for individuals and for the population as a whole. School nurses obviously need professional guidance regarding documentation and ethical challenges. Systematic effort should be directed towards recognition and support of these nurses' unique opportunities to consider, follow and promote all aspects of schoolchildren's health. [ABSTRACT FROM AUTHOR]

In 2005, the Institute of Medicine declared that the prevalence of childhood obesity in the United States ranks as a major health concern. Although the role of television advertising as a possible contributor has received considerable research attention, most previous studies have not included a detailed analysis of children's exposure on all programming or made comparisons with earlier estimates. Therefore, the Bureau of Economics staff at the Federal Trade Commission undertook a comprehensive analysis of television advertising to determine how many and what types of advertisements children are exposed to today and how the findings compare with their exposure before the rise in obesity. This article presents the major findings of the Federal Trade Commission's report and discusses several other issues that help inform the obesity debate. The article's insights will be useful to policy makers, researchers, marketers, and other constituencies involved in developing solutions to the obesity problem. [ABSTRACT FROM AUTHOR]

This article presents an overview of different types of rights to help consideration of, and debate about, children and young people's rights in relation to pediatrics and child health. It investigates how children's rights may or may not differ from adult rights as well as the implications for practice. It discusses that applying a children's right model can be more helpful in pursuing a public child health agenda than in reducing legal or ethical conflicts when interacting with child patients and their families.

Fair play, both in academics and sports, is a concept that is challenged by the notion of performance enhancement. Both cognitive and physical performance can be viewed as potentially enhanceable, and arguments can be made that enhancement can serve two purposes: gaining an edge or keeping up with others (who may or may not have used performance-enhancing substances). Caffeine, a central nervous system and cardiac stimulant, is frequently used by children for both academic and athletic performance enhancement. In fact, the marketplace contains a plethora of caffeinated products marketed directly to children. This article examines safety and ethical issues associated with the use of caffeine by children and explores the question: Can cognitive performance enhancement be ethically permissible if sports performance enhancement is not? [ABSTRACT FROM AUTHOR]

The ‘right not to know’ one's genetic status has been increasingly more recognised in ethical and legal instruments. Yet empirical research is limited, leaving discussion on a theoretical level. There are also divergent ideas as to what extent it should be respected. In this study, we explored the clinical preconditions for disclosure of increased risk of getting diabetes in children. We included questions in the clinical 5-year questionnaire of a predictive screening for the risk of type 1 diabetes (T1DM), asking the respondents (n=7206) whether they wished to be informed of their children's potential risk status. The group of 2% of the respondents who did not want to know about risk status proved to be significantly associated to concern with natural history data (OR 4.03), lack of knowledge (OR 3.17), pressure to participate (OR 2.99) and the child's disease development (OR 2.18). We discuss whether parents’/participants’ ‘no’ to high-risk information may call for a more nuanced response such as information and support, rather than simply respect their wish not to know. We furthermore argue that it is ethically questionable whether the parents’ expressed wish not to know should prima facie override the potential benefits for their child. We conclude that this constitutes sufficient reason not to promote a default solution where people's expressed wishes not to know are taken at face value.European Journal of Human Genetics (2007) 15, 556–562. doi:10.1038/sj.ejhg.5201786; published online 21 February 2007 [ABSTRACT FROM AUTHOR]

The consideration of ethical issues relating to pediatric environmental health is a recent phenomenon. Discussions of biomedical ethics, research on children, and environmental health research have a longer history. In the late 1990s, researchers at the Kennedy Krieger Institute in Baltimore, Maryland, undertook a study to compare the effectiveness of several methods of reducing lead risk in housing. In a preliminary finding in the case of Grimes v. Kennedy Krieger Institute, Inc., a Maryland court questioned the ethics of performing research on children when there is no prospect of direct benefit to those children and whether parents can consent to such research. This case dramatically raised the profile of ethical issues among the pediatric environmental health research community. To broaden the discussion of these issues and in response to the Kennedy-Krieger case, the Children's Environmental Health Network held a working meeting on 5 and 6 March 2004 to explore this topic. The articles in this mini-monograph were prepared by the authors as a result of the workshop and represent their opinions. This article is an introduction to the workshop and a summary of the articles to follow. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of issues raised by conducting research in the area of chronic childhood illness, using the example of childhood cancer. Methods: This literature review used informal methods. Results: Children with cancer and their families may participate in a wide variety of studies in different research traditions, including social science studies, epidemiological, biological and genetic research, and clinical trials. Different concerns about research participation have been raised in these different contexts. Sociological debate has tended to characterize exclusion from research as a manifestation of assumptions of poor competence on the part of children, and to see inclusion in research as a means of restoring proper balance in power relations and giving children a voice. The ethical imperative within clinical research, on the other hand, has been in favour of protection of individuals from risk or direct harm. Lack of consensus on issues such as the status of children's consent for research participation persists, in part because debates have taken place within rather than across disciplinary boundaries, and in part because of a tendency to debate issues as ethical principles in an empirical vacuum. The lack of research on the experiences and views of those asked to take part in childhood cancer research is striking. Discussion: It is important that debates about the involvement of children in research are informed by high-quality social science research and by interdisciplinary dialogue. [ABSTRACT FROM AUTHOR]

The millennium has ushered in a new era of oversight for pediatric research, with renewed moral and legal attention to the upper thresholds of potential harms to which children may be exposed in studies. Watershed events discussed include: First, the deaths of two research subjects, allegedly due to insufficient oversight by the investigators and their institutional review boards. Second, the courts expressed concerns about research policies for incompetent persons or children in two cases, T.D. v. N.Y. and Grimes v. Kennedy Krieger Institute, and reinforcement of the principle that the best interest standard must be used for incompetent persons even in research. Third, the Best Pharmaceutical for Children Act and the Pediatric Rule created incentives as well as uncertainty among Institutional Review Boards and researchers about conducting pediatric studies. Fourth, the Office of Human Research Protection signaled the start of more rigorous oversight with its public rebuke and suspension of a National Institute of Child Health and Human Development pediatric obesity study. Failure to clarify the meaning of the pediatric regulations has sometimes misled generally risk-averse institutions and dedicated investigators about what is permissible. [ABSTRACT FROM AUTHOR]

Mothers serve as an important layer of the health-care system, with special responsibilities to care for the health of families and nations. In our social discourse, we tend to treat maternal "choices" as though they were morally and causally self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers' caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. [ABSTRACT FROM AUTHOR]

In anticipation of the National Children's Study, lessons can be learned from the smaller birth cohort studies conducted by five Centers for Children's Environmental Health and Disease Prevention Research funded by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency. The populations studied are diverse in ethnicity and social class and reside in urban and rural environments. Although almost all of the centers chose to enroll participants through medical care facilities, they had to develop independent staffs and structures because of the overburdened medical care system. Some of the lessons learned by the centers include the importance of continuous funding, building community partnerships to conduct culturally appropriate research, hiring bilingual and bicultural staff from the community, prioritizing research goals, developing biorepositories to ensure future utility of samples, instituting quality control procedures for all aspects of specimen and data collection, maintaining frequent contact with study participants, ensuring ethical conduct of the research in a changing medical-legal climate, and communicating results in a timely and appropriate manner to participants and the wider community. All centers underestimated the necessary start-up time, staff, and costs in conducting these birth cohort studies. Despite the logistical complexity and added expenses, all centers emphasize the importance of studying the impact of environmental exposures on those children most at risk, those living in minority and low-income communities. These centers present barriers encountered, solutions found, and considerations for future research, with the hope that the lessons learned can help inform the planning and conduct of the National Children's Study. [ABSTRACT FROM AUTHOR]

Caregivers sometimes feel frustrated by present emphasis on self-determination in the care for individuals with an intellectual disability. They are confronted with situations in which there is a conflict between providing high quality care and respecting the client's autonomy. Such conflicts are prominent in the care for people with Prader–Willi syndrome (PWS). This condition is characterized by overeating behaviour which frequently leads to serious obesity. The central question in the present study is how persons involved, parents and professional caregivers, deal with the problems of the prevention of obesity in young individuals with PWS in everyday life.In-depth qualitative interviews were conducted with 23 parents and 14 professional caregivers of 18 persons with PWS. The interview data were analysed using the constant comparative method as described in grounded theory.On the basis of analysis of the interviews four values emerge that parents and professional caregivers indicate as relevant and directive to their acting towards the child or the client: physical health, well-being, freedom and responsibility, and a liveable life. Furthermore, caregivers mentioned several enabling and limiting conditions that influence these values. And they named several interventions they used to realize the values.Of importance is the question how to create life in such a way that it is acceptable and meaningful for everybody involved. By building up a relationship to which acceptance and trust are central, a certain amount of independence and responsibility can be promoted. By creating trust it is possible to deal with rules in a less rigid way and to look where there is room for choices. [ABSTRACT FROM AUTHOR]